Citation Nr: 9825687
Decision Date: 08/26/98 Archive Date: 07/27/01
DOCKET NO. 94-15 659 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Huntington,
West Virginia
THE ISSUES
1. Entitlement to service connection for a chronic acquired
psychiatric disability.
2. Entitlement to an increased evaluation for colitis,
currently evaluated as 10 percent disabling.
REPRESENTATION
Appellant represented by: Richard Paul Cohen, Attorney-
at-Law
WITNESSES AT HEARING ON APPEAL
Appellant, his mother and Diana Price
ATTORNEY FOR THE BOARD
Robert E. O'Brien, Counsel
INTRODUCTION
The veteran had active service from August 1976 to April
1979.
This case was previously before the Board of Veterans'
Appeals (Board) in September 1997, at which time it was
remanded to the Department of Veterans Affairs (VA) Regional
Office (RO) in Huntington, West Virginia, for further
development. The requested actions have been completed and
the case has been returned to the Board for appellate review.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran and his representative essentially maintain that
he began to experience early symptoms of schizophrenia during
service and, therefore, his current diagnosis of
schizophrenia warrants service connection for the disorder.
With regard to colitis, the veteran states that he has
stomach cramps and pain on a daily basis. He also asserts
that he bleeds about 2 or 3 times a week. It is contended
the severity of the condition warrants a rating higher than
the 10 percent currently in effect.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1998), has reviewed and considered
all of the evidence and material of record in the veteran's
claims files. Based on its review of the relevant evidence
in this matter, and for the following reasons and bases, it
is the decision of the Board that the evidence is in
equipoise, and warrants a grant of service connection for
paranoid schizophrenia. It is also the decision of the Board
that the preponderance of the evidence is against the claim
for a rating in excess of 10 percent for colitis.
FINDINGS OF FACT
1. It is more likely than not that the veteran's
schizophrenia had its onset during his active service.
2. The veteran complains of alternating constipation and
diarrhea and chronic abdominal pain.
3. Colon biopsies done in late 1997 showed no increase in
inflammation and no crypt atrophy.
4. More than a moderately disabling disorder of the
digestive system has not been shown.
CONCLUSIONS OF LAW
1. With resolution of all reasonable doubt, schizophrenia
was incurred during the veteran's active service.
38 U.S.C.A. §§ 1131, 5107(b) (West 1991); 38 C.F.R.
§ 3.203(b) (1997).
2. The criteria for a rating in excess of 10 percent for
colitis have not been met. 38 U.S.C.A. §§ 1155, 5107(b)
(West 1991); 38 C.F.R. §§ 4.3, 4.7, 4.114, Diagnostic
Code 7323 (1997).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
I. Service Connection for Schizophrenia
The claim for service connection is well grounded within the
meaning of 38 U.S.C.A. § 5107(b) (West 1991), and the
evidence of record adequate.
Service connection may be granted for disability resulting
from disease or injury incurred in or aggravated by active
service. 38 U.S.C.A. § 1131. In pertinent part, for the
showing of chronic disease in service, there are required a
combination of manifestations sufficient to identify the
disease entity, and sufficient observation to establish
chronicity at the time, as distinguished from merely isolated
findings or diagnoses including the word "chronic."
Continuity of symptomatology is required only where the
condition noted during service (or in the presumptive period)
is not, in fact, shown to be chronic, or where the diagnosis
of chronicity may legitimately be questioned. When the fact
of chronicity in service is not adequately supported, then a
showing of continuity after discharge is required to support
the claim. 38 C.F.R. § 3.303(b). Service connection may be
granted for any disease diagnosed after discharge when all
the evidence, including that pertinent to service,
establishes that the disease was incurred in service.
38 C.F.R. § 3.303(d). Initially, service connection may be
granted for diseases which includes schizophrenia, although
not otherwise established as incurred in service, if the
disease is manifested to a compensable degree of 10 percent
or more within the first year following service discharge.
38 C.F.R. § 3.309(a) (1997).
A review of the available service medical records, including
the report of separation examination in April 1979, reflects
no psychiatric complaints or abnormalities.
Of record are reports of private medical treatment and
evaluation of the veteran beginning in December 1979. It was
noted that the veteran was having relationship problems with
his parents and was having difficulty with his wife of
3 years. The impressions included depression, anxiety,
identity complex, and marital maladjustment.
At the time of the general medical examination by VA in May
1980, there were no complaints regarding the veteran's
psychiatric status. The veteran's nervous system was
described as within normal limits.
The veteran was seen at the West Virginia University Hospital
in November 1981. It was indicated his wife had filed for
divorce. He described the various difficulties he and his
wife had been having. He was described as angry and
occasionally close to tears. It was indicated he was without
psychosis or suicidal intent. However, it was noted that he
had cut his left wrist with a dull knife as a gesture about
2 weeks previously. The assessment was continued marital
maladjustment with ambivalence. Notation was made of
atypical depression.
The veteran was hospitalized at a private facility in August
1987. His medical history was obtained from family members
at the time of admission. He complained that he did not know
why he was brought to the facility. It was reported that
about 6 years prior to hospitalization he had begun
exhibiting paranoid ideation about the Mafia "being out to
get me." He was followed for a time by a physician who felt
that he had atypical depression and he was treated with
medication. He was lost from follow-up when he apparently
moved to another state to live with his sister. He returned
to the West Virginia area about 2 years previously and since
then had been noted by family members to exhibit increasingly
bizarre behavior. In addition to verbal assaultiveness
directed toward his mother and his ex-wife, he had reportedly
assaulted an acquaintance of his ex-wife's, and had, on
occasion, stabbed walls in the family home with a knife. He
had apparently suspected his father of attempting to poison
him and reportedly had spoken to his children of "little
voices" that he heard. He had refused contact with medical
care providers. Family members had become increasingly
fearful for their own welfare because of his erratic and
threatening behavior.
On evaluation, an Axis I impression was made of probable
paranoid schizophrenia. It was stated that his past
psychiatric history and reports from the family of
occurrences during the past several years supported the
diagnosis. Firsthand data derived from an evaluation of the
veteran was reportedly limited due to the veteran's
negativism. It was remarked that there was strong evidence
that he had significant psychiatric disturbance which
required treatment.
The veteran was hospitalized by VA in September 1987
following transfer from the State facility where he had been
for the past 30 days under a probable cause commitment. The
veteran had had increased psychosis with hearing voices and
seeing people who had been trying to kill him. He had shown
little improvement in his hospital stay at the State facility
was well as at the VA facility, even though he had received
treatment with antipsychotic medication. The veteran stated
he had had the problem for 11 years, but had never been
treated prior to his initial commitment at the State
hospital. The veteran was given a diagnosis of
schizophrenia.
The veteran was accorded a psychiatric examination for VA in
March 1990. He stated that he heard voices while in service,
beginning in 1978 when he was stationed at Camp Lejeune,
North Carolina. He reported that he saw a doctor in North
Carolina and also while stationed in Okinawa, but was never
hospitalized for psychiatric purposes. He claimed the voices
were telling him he was going to be followed and was going to
be killed. He claimed that over the years the voices had
gotten worse. He had been to a mental health clinic and was
receiving counseling from that facility. He also referred to
the aforementioned periods of hospitalization at the State
facility and VA facility.
The diagnosis was paranoid schizophrenia. The examiner
commented that the veteran had a "long history" of a mental
disorder in which he had been very suspicious, was
hallucinating and was hearing voices telling him he was going
to be killed.
The subsequent medical evidence includes an April 1991
statement from a psychologist with the Valley Comprehensive
Community Mental Health Center in Morgantown, West Virginia.
The individual indicated that she was aware that the VA had
denied the veteran service connection for a chronic acquired
psychiatric disorder on the basis that his service medical
records were completely negative for complaints or findings
of psychiatric abnormalities. She indicated that on the
other hand, both of the veteran's parents and his ex-wife
substantiated that they saw drastic changes in him even in
boot camp. The veteran's wife described an increase in
nervousness, severe mood swings, and intense paranoia. This
behavior was substantiated by the veteran's parents at the
time he was serving on active duty and upon his discharge and
return home. The veteran's father pointed to two letters
written home from the veteran from boot camp in which he
expressed a great deal of fear.
The psychologist believed that due to the veteran's fears
connected with service and his general paranoia, it was
"unlikely" that he would openly share his thoughts and
feelings with the medical personnel at boot camp or in
Okinawa. She also noted that it would be "unlikely" that a
young person would seek professional help in a timely manner.
She believed it was much more likely that help for the
illness would only be sought when the individual could no
longer function in his or her normal routine. She also
reported that "when you review the literature, no matter what
the reason for the predisposition of schizophrenia, the
likely time for its initiation in males is between the ages
of 16 and 20. It is not unusual to find the illness
beginning when a young person leaves home to assume new
responsibilities, e.g., marriage, service, or school." She
believed this fit the veteran's profile. She gave the
veteran a diagnosis of paranoid schizophrenia and opined that
"although his first documented treatment was in 1980 and at
that time was diagnosed as anxiety reaction, it is my
clinical belief that he was demonstrating symptoms of
paranoid schizophrenia since boot camp in 1976."
Received in 1991 were copies of a letter dated in October
1990 from the veteran's ex-wife and a copy of a letter dated
in October 1990 from the veteran's mother. The
communications reflected problems the veteran had during
service and what a changed person he was following his
separation from service. It was indicated that the veteran
heard voices during his military service.
Additional evidence of record includes an October 1992
communication from a psychiatrist at the Family Comprehensive
Community Mental Health Center. The veteran's chief
complaint was paranoid delusions and hallucinations which
reportedly began during military service while stationed in
Japan. She indicated that the veteran reported having joined
the military at the age of 18 in August 1976 and describing
himself as "nervous from day one." While located in the
United States, the veteran reportedly had insomnia, weight
loss, and tremulousness. It was indicated that while
stationed in Japan, the veteran developed paranoid delusions
thinking that people were following him. He also suffered
from auditory hallucinations and thought broadcasting. He
stated that at first he did not want to tell anybody because
he did not want them to think he was crazy. He reported that
he eventually sought a physician who advised him that he was
undergoing stress which would eventually go away. However,
he indicated that it never did go away. The veteran's mother
stated that when he returned to the United States, he
continued to experience paranoid delusions and to believe
that his family was trying to poison him. He was seclusive
and locked himself in his room.
According to the veteran's ex-wife, he displayed other
psychotic behavior after his return from Japan such as
washing his money because he thought people were trying to
poison him, putting aluminum foil on the windows so that
people could not see in, and putting spoons or knives in the
door, so no one could get in. He became distrustful and
thought that everyone was out to get him. He became violent,
moody, socially withdrawn, and unable to handle stress.
The psychiatrist gave the veteran an Axis I diagnosis of
paranoid schizophrenia. There was no Axis II diagnosis. The
psychiatrist opined that "it can definitely be stated that
the illness...began in 1976 when [the veteran] entered the
military service." She added that the prodromal phase of the
schizophrenic illness began while stationed in North Carolina
and the active phase, including hallucinations and delusions,
began during his assignment to Japan. The veteran's illness
reportedly showed the typical cause of schizophrenia with
onset in early adulthood, precipitated by a psychosocial
stressor, acute exacerbations, residual impairment between
episodes, and deterioration which did not allow him to return
to full functioning. The basis for opining on the onset of
the illness was "(1) the patient's report of symptoms, (2)
reported symptoms by the patient's mother and ex-wife, (3)
this clinician's knowledge of the course for schizophrenic
illness. Due to the clinical causes of schizophrenia, that
is no doubt that his illness started during, rather than
after, his military service."
The subsequent medical evidence shows reports of VA
hospitalization of the veteran from December 1993 to February
1994. It was reported the veteran's current distress was
aggravated by marital and relationship difficulties within
his family. He stated that he began having recognizable
symptoms of schizophrenia while in service. The final Axis I
diagnosis was paranoid schizophrenia with acute psychosis.
The veteran has continued to receive treatment and evaluation
for schizophrenia since then. In October 1997 he was
accorded a psychiatric examination by VA. He was currently
working at a Burger King 2 hours, 2 days a week. According
to the veteran, he had been diagnosed as a paranoid
schizophrenic at the age of 19. He claimed that he saw
things and heard things. He stated that the voice he heard
was God's. He indicated God spoke to him and he thought he
was really special. He claimed he saw demons and God talked
to him saying that he was there to help the veteran. He
reported that he used drugs at age 17 and smoked marijuana
since age 19 and "still do." He denied any other street
drugs. He stated that he went to see a doctor when stationed
in Japan and complained of hearing voices at the end of 1978
because "they turned me in." According to a review of the
record by the examiner, there was nothing to substantiate the
veteran receiving any psychiatric treatment or receiving any
antipsychotic medication until 1984 when he was hospitalized
at a State facility. He reported that since his first
hospitalization in 1984, he had been hospitalized at least
1 to 2 times a year.
On current examination he stated that he still believed there
was a conspiracy being plotted against him. He denied any
suicidal or homicidal ideation, although reference was made
to one attempt in the past when he cut his wrist. He
reported this happened when his wife was leaving him in 1984.
Following examination, an Axis I assessment of paranoid
schizophrenia, in remission, was made. Also diagnosed was
marijuana dependence. There was no Axis II diagnosis. The
examiner noted that the veteran "might" have had prodromal
symptoms of schizophrenia during service, "but for sure he
has no acute phase of schizophrenia with hallucinations,
delusions, thought disorder, and disorganized speech." The
examiner noted that even with the veteran's condition, he was
able to work more than 2 years for a service department and
was able to go to college for 2 years. The examiner stated
that "my answer to the question is as follows: The patient's
symptoms are not service connected."
When all of the relevant evidence is assembled, the Board is
responsible for determining whether the evidence supports the
claim or is in relative equipoise, with the appellant
prevailing in either event, or whether a fair preponderance
of the evidence is against the claim, in which case the claim
is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
The veteran, his ex-wife, and his mother have given
consistent testimony over the years that the onset of his
symptoms subsequently diagnosed as chronic schizophrenia was
during his several years of active service particularly his
time spent serving in Japan, but a review of the record
reflects they are lay persons and as such are not competent
to render a medical opinion as to the cause or etiology of
any current psychiatric disability. Espiritu v. Derwinski,
2 Vet. App. 492 (1992).
The records were available for review by various health care
professionals. A psychologist and a psychiatrist at a
community mental health facility where the veteran was
treated and evaluated for psychiatric purposes in the years
following service reviewed the statements made by the
veteran, his ex-wife, and his mother and determined that the
personality changes reported by the veteran's family and
himself were consistent with the prodromal phase of
schizophrenia. These individuals are qualified to render a
competent psychiatric opinion. It is not clear to what
extent they were able to review the entire record, but both
the psychologist and the psychiatrist were clear and concise
and strong in expressing the opinion that the veteran's
schizophrenia had its onset during, rather than after, his
military service. It is not clear how long either individual
had treated or evaluated the veteran, but it is more than
apparent that both individuals saw the veteran more than the
VA psychiatrist who conducted the October 1997 examination.
That examiner was less than concise in rendering his opinion.
While indicating that the veteran "might" have had prodromal
symptoms of schizophrenia during service, it was his
conclusion that the symptoms were not service connected. The
examiner was vague in his comments, while the psychologist
and psychiatrist at the mental health clinic voiced their
comments in a much more definitive tone and therefore a more
persuasive tone.
As the United States Court of Veterans Appeals (Court) has
stated in Smith v. Derwinski, 1 Vet. App. 235, 237 (1991),
"[d]etermination of credibility is a function for the BVA."
The Board finds that it is not unreasonable to conclude that
that the positive evidence which includes an indication that
the veteran was experiencing psychiatric difficulties within
a few months following service discharge and the written
statements from the veteran, his ex-wife, and his mother and
the negative evidence, which includes the available service
medical records which do not indicate the veteran having a
psychiatric disability, and the conflicting medical opinion
as to the etiology of the veteran's schizophrenia are in
relative equipoise. Therefore, service connection for
schizophrenia is granted. 38 U.S.C.A. §§ 1131, 5107(b);
38 C.F.R. § 3.303.
II. Entitlement to a Rating in Excess of 10 Percent for
Colitis
The Board finds that the veteran's claim for an increased
rating is well grounded within the meaning of the statutes
and judicial construction. 38 U.S.C.A. § 5107(a); see
Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). VA has
a duty, therefore, to assist him in the development of facts
pertinent to the claim. The relevant evidence pertaining to
the issue consists of numerous medical records and the
veteran's testimony. The Board concludes that sufficient,
relevant data has been obtained for determining the merits of
the veteran's claim and VA has, therefore, fulfilled its
obligation to assist him in the development of the facts of
his case.
Disability evaluations are based on the average impairment of
earning capacity resulting from disability. The percentage
ratings for each diagnostic code, is set forth in the VA's
Schedule for Rating Disabilities, codified in 38 C.F.R.
Part 4, representing average impairment of earning capacity
resulting from disability. Generally, the degrees of
disability specified are considered adequate to compensate
for a loss of working time proportionate to the severity of
the disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1.
In accordance with the diagnostic code pertaining to the
evaluation of ulcerative colitis, a 10 percent evaluation
applies if the colitis is moderate, with infrequent
exacerbations. The next higher rating of 30 percent is
assigned when the colitis is moderately severe, with frequent
exacerbations. The next higher rating of 60 percent is
assigned when the colitis is severe, with numerous attacks a
year and malnutrition, with health only fair during
remissions. A 100 percent schedular evaluation is for
assignment when the colitis is pronounced, resulting in
marked malnutrition, anemia, and general debility or with
serious complications as liver abscess. 38 C.F.R. § 4.114,
Code 7323.
In the alternative, a 10 percent rating is assigned for
irritable colon syndrome which is moderate, with frequent
episodes of bowel disturbance with abdominal distress. The
maximum rating of 30 percent is assigned when the irritable
colon syndrome (spastic colitis, mucous colitis, and so
forth) is severe, with diarrhea, or alternating diarrhea and
constipation, with more or less constant abdominal distress.
38 C.F.R. § 4.114, Code 7319.
The determination of whether an increased evaluation is
warranted is to be based on the review of the entire evidence
of record and the application of all pertinent regulations.
See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Once the
evidence is assembled, the Secretary is responsible for
determining whether the preponderance of the evidence is
against the claim. If so, the claim is denied; if the
evidence is in support of the claim or is in equal balance,
the claim is allowed. See Gilbert v. Derwinski,
1 Vet. App. 49,55 (1990).
A review of the service medical records shows that the
veteran was seen on several occasions in service for various
complaints, which included fatigue and nausea, loose bowels,
and diarrhea. On one occasion in May 1977 he was given a
diagnosis of dyspepsia. During one visit in June 1978, he
was given a diagnosis of mucous colitis. However, at the
time of the separation examination in April 1979, there was
no indication of any disorder of the digestive system.
Of record is a December 1979 communication from a private
physician indicating the veteran was seen by him in June 1979
with complaints of diarrhea. The physician gave a diagnosis
of ulcerative proctitis and ulcerative colitis. The veteran
was hospitalized at a private facility in December 1979 for
therapy for ulcerative colitis. The final diagnosis was
inflammatory bowel disease.
However, when the veteran was examined by VA in May 1980,
examination was essentially unremarkable. A barium enema was
normal, with no evidence of ulcerative or granulomatous
colitis. The diagnosis was ulcerative colitis not shown by
X-ray study.
The subsequent medical evidence includes VA medical records
indicating a barium enema showing the presence of colitis in
June 1992. VA examination of the veteran in January 1993
included a colonoscopic examination which showed diffuse
inflammatory process of the colon without evidence of
ulceration, polyps, or other mucosal abnormalities. The
biopsy obtained from the colon revealed chronic inflammatory
process. The diagnosis was that of nonspecific colitis.
By rating decision dated in April 1993, service connection
for nonspecific colitis was granted and a 10 percent
evaluation was assigned, from December 30, 1992.
Subsequently, the veteran was seen in the early and mid-
1990's for various complaints. The ulcerative colitis was
described as in remission during VA hospitalization from
January to February 1995. During hospitalization by VA in
January 1996 for psychiatric purposes, ulcerative colitis was
noted by history only.
The veteran was accorded an intestinal examination by VA in
October 1996. The veteran stated that he was treated
individually with Prednisone or other corticosteroid drugs
from 1979 to 1992. The Prednisone had been stopped several
years previously and he had been tried on Azulfidine, but had
developed dizziness, nausea, and emesis. He stated that he
was requesting an increase in compensation benefits because
he was having an increase in right lower quadrant and left
lower quadrant abdominal pain as compared to 3 years ago. He
stated the pain lasted all day. It was described as related
to stress. He did not know what made it better. It was not
better with a bowel movement. He said it could be worse
after meals. He indicated he had 4 to 5 bowel movements
daily and these were soft. He further related that he was
now passing more blood and mucus from the rectum. He
complained that he had blood in his stools 3 to 4 times
weekly. Weight was unchanged in the past 8 months. He
reported he had been unable to work for many years. There
were no extra intestinal manifestations of inflammatory bowel
disease. A review of a rectal biopsy from 1995 showed only
slight fecal congestion. Hemoccult was negative. It was the
examiner's impression that the veteran likely had irritable
bowel syndrome. The examiner stated that it was unlikely
that the veteran had ulcerative colitis.
In December 1996 the veteran was accorded an examination at a
VA medical facility. Rectal examination showed a single
external hemorrhoid that was otherwise normal. A video
colonoscope was utilized. It was easily advanced to the
level of the cecum. About 10 percent of the ascending colon
and cecal mucosa were occluded by retained stool. The
ileocecal valve appeared normal. There was mild friability
of the ascending colon and mucosa. Upon withdrawal of the
instrument, normal mucosa was observed. There were two
polyps about 2 millimeters in size in the rectum and they
appeared hyperplastic. The impressions were external
hemorrhoids and rule out colitis, likely irritable bowel
syndrome.
The veteran was accorded another rating examination by VA in
October 1997. It was noted the examination was conducted by
the same physician who had evaluated the veteran in October
1996. The veteran's weight at that time was recorded as
87 kilograms, while his current weight was given as
84.6 kilograms. Complaints included diffuse abdominal pain
and periodic blood on bowel movements. It was indicated that
random biopsies obtained from the ascending colon, the
transverse colon, the descending colon, the sigmoid colon,
and the rectum had been read by the Armed Forces Institute
for Pathology, and it was determined that no lesions had been
seen. Previous laboratory evaluations included no
Helicobacter pylori serology. The examiner noted that the
veteran's recent weight loss and his complaints of epigastric
pain with nausea and emesis might represent cholecystitis.
The veteran reportedly described symptoms which were
consistent with irritable bowel syndrome. It was indicated
that VA would again exclude colitis. With the veteran's
history of paresthesias, diabetic gastropathy was indicated
as possibly being the cause of vomiting. It was the
assessment that the veteran's colitis-like symptoms were not
causing any major impairment in his daily life. The veteran
was not up at night to have any bowel movements. Also, he
had no fecal incontinence. He was only having 2 to 3 small
bowel movements daily. Further testing was suggested.
In December 1997 the veteran underwent colonoscopy with
biopsy and esophagogastroduodenoscopy with biopsy. The
veteran was described as an individual who had alternating
constipation and diarrhea. The veteran had recently had a
normal hemoglobin, MCA and platelet count. He had a normal
serum calcium, creatinine, potassium, and protium. He had a
normal thyroid-stimulating hormone, thus excluding
hyperthyroidism as a cause of diarrhea. He also had normal
liver tests. Further, he had normal serum magnesium and he
had a negative serology for Helicobacter pylori.
Colonoscopic examination was unremarkable except for the
notation of a single hemorrhoid internally. On
esophagogastroduodenoscopic examination, normal mucosa was
observed in the esophagus. There was diffuse gastritis of
the body of the stomach manifested by shallow erosions which
were diffuse. There was also mild erythema. No ulceration
was noted. The pylorus had normal mucosa. The duodenum also
had normal mucosa. The examiner stated it was likely the
veteran had irritable bowel syndrome. Also diagnosed were
hiatal hernia, gastritis, and internal hemorrhoids.
A January 1998 communication from the Armed Forces Institute
of Pathology revealed that the colon biopsies accorded the
veteran showed no increase in inflammation and no crypt
atrophy. The esophageal biopsy showed intraepithelial
eosinophils which was most commonly seen in reflux
esophagitis. However, it was noted hypersensitivity to drugs
and foods could give the same histological features. The
gastric and duodenal biopsies were essentially normal.
Of record is a February 1994 communication from Robert M.
D'Alessandri, M.D., the Vice President for Health Sciences
and the Dean of the School of Medicine at the Robert C. Bird
Health Sciences Center of West Virginia University. He
indicated that in response to questions he had received from
the veteran's representative in June 1993, he was able to
state that during periods of remission, both a barium enema
and proctosigmoidoscopy often revealed normal findings.
During acute bouts of ulcerative colitis, a
proctosigmoidoscopic exam with a biopsy might be diagnostic
whereas the barium enema might not be. In the veteran's
case, the sigmoidoscopy revealed friable mucosa, but the
biopsy only showed chronic inflammation. The physician
stated this was not unusual in patients with ulcerative
colitis. He believed it would have been more helpful had the
biopsy been more specific. The physician stated that during
the time he treated the veteran, the diagnosis was ulcerative
colitis. He added that during that time, the veteran's
condition was first characterized as moderately severe with
frequent exacerbations. He further indicated that ulcerative
colitis was a chronic condition which predisposed an
individual to the development of carcinoma of the colon. He
noted the condition was characterized by recurrent
exacerbations and remissions. He further indicated that
remissions might be short lived or might last a long time,
but added this was very hard to predict.
In view of the foregoing, the Board believes that the
evidence of record does not show that the veteran meets the
criteria for an evaluation of 10 percent whether the disorder
is rated under ulcerative colitis or irritable bowel
syndrome. There is no indication that the veteran's symptoms
more nearly approximate the rating criteria for a rating in
excess of 10 percent under any of the appropriate codes for
rating the disability. It is true that a private physician
stated in a February 1995 communication that he would
describe the veteran's condition as moderately severe with
frequent exacerbations, a description which would warrant the
assignment of a 50 percent rating under Diagnostic Code 7323
for ulcerative colitis. However, the records subsequent
thereto do not indicate the presence of symptoms which could
be described as representative of a moderately severe
condition with frequent exacerbations.
At the time of examination by VA in October 1997, the
examiner specifically stated that the veteran's colitis-like
symptoms were not causing any major impairment in his daily
life. The veteran had "numerous tests and procedures and
biopsies," the results of which confirmed this. The most
recent biopsies were reviewed by the Armed Forces Institute
of Pathology in early 1998 and did not show any findings
which would be indicative of the presence of a disability
which would warrant a higher rating at this time. While the
esophageal biopsy showed eosinophils, the colon biopsies
showed no increase in inflammation and no crypt atrophy, and
the gastric and duodenal biopsies were essentially normal.
The biopsy review followed an examination by VA in December
1997 at which time the findings were not such as would meet
the criteria for a rating in excess of 10 percent.
Colonoscopic examination at that time was essentially
unremarkable. Further, the pylorus and duodenum revealed
normal mucosa. There was gastritis shown, but it was diffuse
and no ulceration was indicated. Accordingly, the Board
believes that the criteria for a rating in excess of
10 percent have not been met at this time.
ORDER
Service connection for paranoid schizophrenia is granted. To
this extent, the appeal is allowed.
A rating in excess of 10 percent for colitis is denied.
Robert E. O'Brien
Acting Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1998), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.